Healthcare Provider Details

I. General information

NPI: 1780371971
Provider Name (Legal Business Name): AGNES KONADU ARHIN APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/19/2023
Last Update Date: 11/11/2024
Certification Date: 11/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21 GRAND ST
HARTFORD CT
06106-1541
US

IV. Provider business mailing address

2 MATTHEW LN
BROAD BROOK CT
06016-1006
US

V. Phone/Fax

Practice location:
  • Phone: 860-550-7559
  • Fax: 860-550-7596
Mailing address:
  • Phone: 860-348-7148
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number143457
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number143457
License Number StateCT
# 3
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number11929
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: